Melasma: Ascorbic Acid Versus Hydroquinone
One in five consultations with the Cosmetic Dermatologist is about pigment spots or Melasma. Pigment spots can be stubborn and can make you look (maybe even more so than wrinkles) older than you actually are. If you see all the “enlightening” products available on the shelves you ‘ll be fooled into thinking that these annoying spots are simple to get rid of. But it’s not that easy. So, before you decide to spend out on this type of product I advise you to read a bit more on this subject!
Help! What can I do about it?
There are indeed products and treatments available that can help with pigment spots and with a bit of perseverance a good result is achievable. Generally the best results are achieved by combining laser treatment with up-to-date products. The ultimate success depends mainly on the ‘type’ of pigmentation. Apart from people with the so called UV spots (old age spots), I see a number of young women in the clinic who are suffering from melasma. Melasma are irregularly shaped brown spots arising due to a combination of genes, sunlight, heat and hormonal changes. They appear mainly in women (90%) and mostly those in the child bearing age group. They often flare up during pregnancy. In which case they are often aptly referred to as the pregnancy mask. The spots are often very disturbing and difficult to treat.
The impact of Hydroquinone and Ascorbic Acid on melasma
16 women with melasma applied a cream containing 5% Ascorbic Acid to one side of their face and to the other side a cream containing 4% Hydroquinone. They did this for 16 weeks. In the examples left you can see the outcome of the results for Ascorbic Acid, and in the examples on the right the outcome for Hydroquinone.
Both creams worked well for most of the women:
The cream containing 4% Hydroquinone gave a good to excellent result in 93% of the women – 11 of the 16 women experienced side effects.
The cream containing 5% Ascorbic Acid saw a significant improvement of 62.5% in the skin – only 1 person experienced side effects.
All of test participants used sun cream throughout the trial period.
Fortunately then there are possibilities…
The conclusion drawn from the investigation is that it is not only hydroquinone that can help melasma but also Vitamin C. Although the Hydroquinone gave a better result than the Vitamin C, it also caused more skin irritation. Apart from that, Hydroquinone is only available on prescription and Vitamin C is available over the counter. Unfortunately there are very few products with (at least) 5% Vitamin C available on the market. If ascorbic acid does not appear in the first third of the ingredients list then there is almost certainly an insufficient amount in the product. Also a product containing Vitamin C needs to be stored in an airtight container as both Ascorbic Acid and the stabilized form of Vitamin C (e.g. Sodium Ascorbyl Phosphate) react poorly to oxygen. Its therefore best to search for a product with a pump dispenser.
(Dr. Jetske Ultee-Research Physician Cosmetic Dermatology)